Basic knowledge related to BUCCAL i.e The oral cavity is an attractive site for drug delivery due to ease of administration and avoidance of possible drug degradation in the gastrointestinal tract and first-pass metabolism.
There are four potential regions for drug delivery in the oral cavity, namely buccal, sublingual, palatal, and gingival.
Buccal drug delivery specifically refers to the delivery of drugs within/through the buccal mucosa to affect local/systemic pharmacological actions.
2. Introduction
■ The oral cavity is an attractive site for drug delivery due to
ease of administration and avoidance of possible drug
degradation in the gastrointestinal tract and first-pass
metabolism
■ There are four potential regions for drug delivery in the oral
cavity, namely buccal, sublingual, palatal, and gingival
■ Buccal drug delivery specifically refers to the delivery of
drugs within/through the buccal mucosa to affect
local/systemic pharmacological actions.
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3. Introduction
■ Buccal-delivered drugs may be used for treatment of
diseases in the oral cavity or for systemic use
■ Limitations of buccal delivery include:
– short residence time
– small absorption area
– barrier property of the buccal mucosa
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5. Anatomy and Biochemistry of Oral
Mucosa
■ The lining mucosa of the oral cavity is covered by a
stratified, nonkeratinized squamous epithelium
■ Although the surface area of the oral mucosa is relatively
small in comparison to the skin and the GI tract, its high
vasculature lends itself to potential drug absorption.
■ The oral cavity may be divided into three sections
depending on variations in the thickness and nature of the
mucosal lining:
– The sublingual mucosa
– The buccal mucosa
– The soft palate
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6. Sublingual mucosa
■ The sublingual mucosa lines the floor of the mouth and is
the thinnest and the most permeable region in the oral
cavity
■ It is supplied with high blood flow and has sufficient
surface area to make it a location of choice when rapid
absorption/onset of drug action is necessary
■ However, its surface is constantly washed by saliva and
this plus tongue activity which makes it difficult to keep
the dosage form in contact with the mucosa
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7. Buccal mucosa
■ The buccal mucosa lines the interiors of the cheek and can
be used for systemic as well as local delivery
■ The surface of buccal mucosa is smooth, relatively immobile,
and more permeable than other mucosal tissues makes it a
location of choice for controlled release systems that need to
stay adhered for an extended period
■ Buccal mucosa is also more robust and tolerant to irritation
and permanent damage from adhesion
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8. Buccal mucosa
■ Salivary production and composition may contribute to
chemical modification of certain drugs
■ Involuntary swallowing can result in drug loss from the
site of absorption
■ Constant salivary scavenging within the oral cavity makes
it difficult for dosage forms to be retained for an extended
period of time to facilitate absorption
■ The relatively small absorption area and barrier properties
can limit this route of delivery
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9. Soft palate
■ The soft palate is suspended from the posterior border of
the hard palate connecting the oral and nasal parts of the
pharynx in the roof of the oral cavity
■ The palatal mucosa found in the oral cavity is highly
vascularized, thin and mostly covered with stratified
squamous epithelium
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11. Mucoadhesive polymers
■ Mucoadhesives are synthetic or natural polymers
that interact with the mucus layer covering the
mucosal epithelial surface and main molecules
constituting a major part of mucus
■ The concept of mucoadhesives has alerted many
investigators to the possibility that these polymers
can be used to overcome physiological barriers in
long-term drug delivery
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12. Mucoadhesive polymers
■ The polymers most commonly used in buccal dry or partially
hydrated dosage forms include polyacrylic acid (PAA), polyvinyl
alcohol (PVA), sodium carboxy methylcellulose (NaCMC) and
sodium alginate
■ New generation of mucoadhesive polymers (with the exception
of thiolated polymers) can adhere directly to the cell surface,
rather than to the mucus. They interact with the cell surface by
means of specific receptors or covalent bonding instead of non-
specific mechanisms, which are characteristic of the previous
polymers. Examples of such are the incorporation of L-cysteine
into thiolated polymers and the target-specific, lectin-mediated
adhesive polymers
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13. Mucoadhesive polymers
■ Thiolated polymers are mucoadhesive polymers, which
display thiol bearing side chains. These polymers are
obtained by addition of conjugated sulfhydryl groups
■ The presence of thiol groups allows the formation of
covalent bonds with cysteine-rich sub domains of the mucus
gel layer, leading to increased residence time and improved
bioavailability
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14. Enzyme Inhibitors
■ The co-administration of a drug with enzyme inhibitors is
another strategy for improving the buccal absorption of drugs,
particularly peptides.
■ Enzyme inhibitors, such as aprotinin, bestatin, puromycin and
some bile salts stabilize protein drugs by different mechanisms,
including:
– affecting the activities of the enzymes
– altering the conformation of the peptides or proteins
– rendering the drug less accessible to enzymatic degradation
■ It has been shown that some mucoadhesive polymers can act as
an enzyme inhibitor
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15. Enzyme Inhibitors
■ Investigations have demonstrated that polymers, such as
poly(acrylic acid), operate through a competitive mechanism
with proteolytic enzymes
■ This stems from their strong affinity to divalent cations (Ca2+,
Zn2+). These cations are essential cofactors for the
metalloproteinases, such as trypsin
■ Studies suggest that Ca2+ depletion, mediated by the presence of
some mucoadhesive polymers, causes the secondary structure of
trypsin to change, and initiates a further autodegradation of the
enzyme
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16. Buccal mucoadhesives dosage forms can be
categorized into three types based on their
geometry illustrated in the following:
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17. Buccal Dosage Forms
■ Type І: It is a single layer device with multidirectional drug
release This type of dosage form suffers from significant drug
loss due to swallowing
■ Type ІІ: In this type, an impermeable backing layer is
superimposed on top of the drug loaded bioadhesive layer,
creating a double-layered device and preventing drug loss from
the top surface of the dosage form into the oral cavity
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18. Buccal Dosage Forms
■ Type ІІІ: This is a unidirectional release device, from
which drug loss is minimal, since the drug is released only
from the side adjacent to the buccal mucosa. This can be
achieved by coating every face of the dosage form, except
the one that is in contact with the buccal mucosa
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19. Buccal dosage forms
■ Buccal Tablets
■ Buccal patches
■ Buccal films
■ Buccal gels and ointments
■ Innovative Drug Delivery Systems
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21. Buccal Tablets
■ Buccal tablets are small, flat, and oval shaped dosage
form and unlike conventional tablets allow for
drinking and speaking without major discomfort.
■ They soften, adhere to the mucosa and are retained in
position until dissolution and/or release is complete
■ Can be used for both local and systemic drug delivery
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22. Buccal patches
■ Buccal patches are described as laminates which comprise an
impermeable backing layer, a drug-containing reservoir layer
which releases the drug in a controlled manner, and a bioadhesive
surface for mucosal attachment
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24. Buccal films
■ Buccal films are preferable over mucoadhesive tablets in
terms of patient comfort and flexibility and they ensure
more accurate drug dosing and longer residence time
compared to gels and ointments
■ Buccal films also reduce pain by protecting the wound
surface and hence increase the treatment effectiveness
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25. Buccal films
■ An ideal buccal film should be flexible, elastic, and soft
yet strong enough to withstand breakage due to stress
from activities in the mouth
■ Moreover, it should also possess good mucoadhesive
strength so that it is retained in the mouth for the
desired duration
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26. Buccal gels and ointments
■ These are semisolid dosage forms having the advantage of
easy dispersion throughout the oral mucosa
■ The problem of poor retention of gels at the application
site has been overcome by using bioadhesive formulations
■ Certain bioadhesive polymers for example, sodium
carboxymethylcellulose undergo a phase change from a
liquid to a semisolid. This change enhances or improves
the viscosity, resulting in sustained or controlled release
of drugs.
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27. Innovative Drug Delivery
Systems
■ A novel liquid aerosol formulation (Oral-lyn, Generex Biotechnology) has
been recently developed, and it is now in clinical phase III trials
■ This system allows precise insulin dose delivery via a metered dose inhaler
in the form of fine aerosolized droplets directed into the mouth
■ This oral aerosol formulation is rapidly absorbed through the buccal
mucosal epithelium, and it provides the plasma insulin levels necessary to
control postprandial glucose rise in diabetic patients
■ This novel, pain-free, oral insulin formulation has a number of advantages
including rapid absorption, a simple (user-friendly) administration
technique, precise dosing control (comparable to injection within one unit)
and bolus delivery of drug.
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